Sensors for Vital Signs Monitoring

Sensor technology for monitoring vital signs is an important topic for various service applications, such as entertainment and personalization platforms and Internet of Things (IoT) systems, as well as traditional medical purposes, such as disease indication judgments and predictions. Vital signs for monitoring include respiration and heart rates, body temperature, blood pressure, oxygen saturation, electrocardiogram, blood glucose concentration, brain waves, etc. Gait and walking length can also be regarded as vital signs because they can indirectly indicate human activity and status. Sensing technologies include contact sensors such as electrocardiogram (ECG), electroencephalogram (EEG), photoplethysmogram (PPG), non-contact sensors such as ballistocardiography (BCG), and invasive/non-invasive sensors for diagnoses of variations in blood characteristics or body fluids. Radar, vision, and infrared sensors can also be useful technologies for detecting vital signs from the movement of humans or organs. Signal processing, extraction, and analysis techniques are important in industrial applications along with hardware implementation techniques. Battery management and wireless power transmission technologies, the design and optimization of low-power circuits, and systems for continuous monitoring and data collection/transmission should also be considered with sensor technologies. In addition, machine-learning-based diagnostic technology can be used for extracting meaningful information from continuous monitoring data

Non-invasive hemodynamic monitoring by electrical impedance tomography

The monitoring of central hemodynamic parameters such as cardiac output (CO) and pulmonary artery pressure (PAP) is of paramount clinical importance to assess the health status of the cardiovascular system. However, their measurement requires the insertion of a pulmonary artery catheter, a highly invasive procedure associated with non-negligible morbidity and mortality rates. In this thesis, we investigated the clinical potential of electrical impedance tomography (EIT) - a radiation-free medical imaging technique - as a non-invasive alternative for the measurement of CO and PAP. In a first phase, we investigated the potential of EIT for the measurement of CO. This measurement is implicitly based on the hypothesis that the EIT heart signal (the ventricular component of the EIT signals) is induced by ventricular blood volume changes. This hypothesis has never been formally investigated, and the exact origins of the EIT heart signal remain subject to interpretation. Therefore, using a model, we investigated the genesis of this signal by identifying its various sources and their respective contributions. The results revealed that the EIT heart signal is dominated by cardioballistic effects (heart motion). However, although of prominently cardioballistic origin, the amplitude of the signal has shown to be strongly correlated to stroke volume (r = 0.996, p < 0.001; error of 0.57 +/- 2.19 mL). We explained these observations by the quasi-incompressibility of myocardial tissue and blood. We further identified several factors and conditions susceptible to affect the accuracy of the measurement. Finally, we investigated the influence of the EIT sensor belt position on the measured heart signal. We observed that small belt displacements - likely to occur in clinical settings during patient handling - can induce errors of up to 30 mL on stroke volume estimation. In a second phase, we investigated the feasibility of a novel method for the non-invasive measurement of PAP by EIT. The method is based on the physiological relation linking the PAP to the velocity of propagation of the pressure waves in the pulmonary arteries. We hypothesized that the variations of this velocity, and therefore of the PAP, could be measured by EIT. In a bioimpedance model of the human thorax, we demonstrated the feasibility of our method in various types of pulmonary hypertensive disorders. Our EIT-derived parameter has shown to be particularly well-suited for predicting early changes in pulmonary hemodynamics due to its physiological link with arterial compliance. Finally, we validated experimentally our method in 14 subjects undergoing hypoxia-induced PAP changes. Significant correlation coefficients (range: [0.70, 0.98], average: 0.89) and small standard errors of the estimate (range: [0.9, 6.3] mmHg, average: 2.4 mmHg) were found between our EIT-derived systolic PAP and reference systolic PAP values obtained by Doppler echocardiography. In conclusion, there is a promising outlook for EIT in non-invasive hemodynamic monitoring. Our observations provide novel insights for the interpretation and understanding of EIT heart signals, and detail the physiological and metrological requirements for an accurate measurement of CO by EIT. Our novel PAP monitoring method, validated in vivo, allows a reliable tracking of PAP changes, thereby paving the way towards the development of a new branch of non-invasive hemodynamic monitors based on the use of EIT

Ultrasound Imaging Innovations for Visualization and Quantification of Vascular Biomarkers

The existence of plaque in the carotid arteries, which provide circulation to the brain, is a known risk for stroke and dementia. Alas, this risk factor is present in 25% of the adult population. Proper assessment of carotid plaque may play a significant role in preventing and managing stroke and dementia. However, current plaque assessment routines have known limitations in assessing individual risk for future cardiovascular events. There is a practical need to derive new vascular biomarkers that are indicative of cardiovascular risk based on hemodynamic information. Nonetheless, the derivation of these biomarkers is not a trivial technical task because none of the existing clinical imaging modalities have adequate time resolution to track the spatiotemporal dynamics of arterial blood flow that is pulsatile in nature. The goal of this dissertation is to devise a new ultrasound imaging framework to measure vascular biomarkers related to turbulent flow, intra-plaque microvasculature, and blood flow rate. Central to the proposed framework is the use of high frame rate ultrasound (HiFRUS) imaging principles to track hemodynamic events at fine temporal resolution (through using frame rates of greater than 1000 frames per second). The existence of turbulent flow and intra-plaque microvessels, as well as anomalous blood flow rate, are all closely related to the formation and progression of carotid plaque. Therefore, quantifying these biomarkers can improve the identification of individuals with carotid plaque who are at risk for future cardiovascular events. To facilitate the testing and the implementation of the proposed imaging algorithms, this dissertation has included the development of new experimental models (in the form of flow phantoms) and a new HiFRUS imaging platform with live scanning and on-demand playback functionalities. Pilot studies were also carried out on rats and human volunteers. Results generally demonstrated the real-time performance and the practical efficacy of the proposed algorithms. The proposed ultrasound imaging framework is expected to improve carotid plaque risk classification and, in turn, facilitate timely identification of at-risk individuals. It may also be used to derive new insights on carotid plaque formation and progression to aid disease management and the development of personalized treatment strategies

Non-invasive ultrasound monitoring of regional carotid wall structure and deformation in atherosclerosis

Thesis (Ph. D.)--Harvard--Massachusetts Institute of Technology Division of Health Sciences and Technology, 2001.Includes bibliographical references (p. 223-242).Atherosclerosis is characterized by local remodeling of arterial structure and distensibility. Developing lesions either progress gradually to compromise tissue perfusion or rupture suddenly to cause catastrophic myocardial infarction or stroke. Reliable measurement of changes in arterial structure and composition is required for assessment of disease progression. Non-invasive carotid ultrasound can image the heterogeneity of wall structure and distensibility caused by atherosclerosis. However, this capability has not been utilized for clinical monitoring because of speckle noise and other artifacts. Clinical measures focus instead on average wall thickness and diameter distension in the distal common carotid to reduce sensitivity to noise. The goal of our research was to develop an effective system for reliable regional structure and deformation measurements since these are more sensitive indicators of disease progression. We constructed a system for freehand ultrasound scanning based on custom software which simultaneously acquires real-time image sequences and 3D frame localization data from an electromagnetic spatial localizer. With finite element modeling, we evaluated candidate measures of regional wall deformation.(cont.) Finally, we developed a multi-step scheme for robust estimation of local wall structure and deformation. This new strategy is based on a directionally-sensitive segmentation functional and a motion-region-of-interest constrained optical flow algorithm. We validated this estimator with simulated images and clinical ultrasound data. The results show structure estimates that are accurate and precise, with inter- and intra-observer reproducibility surpassing existing methods. Estimates of wall velocity and deformation likewise show good overall accuracy and precision. We present results from a proof-of-principle evaluation conducted in a pilot study of normal subjects and clinical patients. For one example, we demonstrate the combination of 2D image processing with 3D frame localization for visualization of the carotid volume. With slice localization, estimates of carotid wall structure and deformation can be derived for all axial positions along the carotid artery. The elements developed here provide the tools necessary for reliable quantification of regional wall structure and composition changes which result from atherosclerosis.by Raymond C. Chan.Ph.D

Measuring blood flow and pro-inflammatory changes in the rabbit aorta

Atherosclerosis is a chronic inflammatory disease that develops as a consequence of progressive entrapment of low density lipoprotein, fibrous proteins and inflammatory cells in the arterial intima. Once triggered, a myriad of inflammatory and atherogenic factors mediate disease progression. However, the role of pro-inflammatory activity in the initiation of atherogenesis and its relation to altered mechanical stresses acting on the arterial wall is unclear. Estimation of wall shear stress (WSS) and the inflammatory mediator NF-κB is consequently useful. In this thesis novel ultrasound tools for accurate measurement of spatiotemporally varying 2D and 3D blood flow, with and without the use of contrast agents, have been developed. This allowed for the first time accurate, broad-view quantification of WSS around branches of the rabbit abdominal aorta. A thorough review of the evidence for a relationship between flow, NF-κB and disease was performed which highlighted discrepancies in the current literature and was used to guide the study design. Subsequently, methods for the measurement and colocalization of the spatial distribution of NF-κB, arterial permeability and nuclear morphology in the aorta of New Zealand White rabbits were developed. It was demonstrated that endothelial pro-inflammatory changes are spatially correlated with patterns of WSS, nuclear morphology and arterial permeability in vivo in the rabbit descending and abdominal aorta. The data are consistent with a causal chain between WSS, macromolecule uptake, inflammation and disease, and with the hypothesis that lipids are deposited first, through flow-mediated naturally occurring transmigration that, in excessive amounts, leads to subsequent inflammation and disease.Open Acces

Detection and analysis of human respiration using microwave Doppler radar

&nbsp;Non-contact detection characteristic of Doppler radar provides an unobtrusive means of respiration detection and monitoring. This avoids additional preparations such as physical sensor attachment or special clothing. Furthermore, robustness of Doppler radar against environmental factors reduce environmental constraints and strengthens the possibility of employing Doppler radar as a practical biomedical devices in the future particularly in long term monitoring applications such as in sleep studies

Detection and analysis of human respiration using microwave Doppler radar

&nbsp;Non-contact detection characteristic of Doppler radar provides an unobtrusive means of respiration detection and monitoring. This avoids additional preparations such as physical sensor attachment or special clothing. Furthermore, robustness of Doppler radar against environmental factors reduce environmental constraints and strengthens the possibility of employing Doppler radar as a practical biomedical devices in the future particularly in long term monitoring applications such as in sleep studies